Urology Coding Alert

Question: A patient presented with a mass in his kidney, and my physician performed a partial nephrectomy. Before closure, he sent biopsies to pathology for frozen sections, which indicated the patient had invasive carcinoma. The physician then performed a total radical nephrectomy. How should I code these procedures?

Colorado Subscriber

Answer: The number of nephrectomy codes subject to CCI edits makes it easy to see how you might be confused about how to code this change in the operative approach. From the little description of the procedure you have provided, you are most likely going to need to use codes 50240 (Nephrectomy, partial) and 50230 (Nephrectomy, including partial ureterectomy, any open approach including rib resection; radical, with regional lymphadenectomy and/or vena caval thrombectomy).

There are no CCI edits that bundle 50240 into 50230, nor are these codes designated "mutually exclusive" of one another. Therefore, you should not need to use any special modifiers when billing these procedures together. Just be sure to include sufficient documentation and diagnostic codes that support medical necessity. Use 50240 and 50230-51 (Multiple procedures). The partial nephrectomy has higher relative value units, RVU, and therefore is coded as the first or primary procedure billed.